Feeding the children

Maureen Black's commitment to helping poor children inspires her to move seamlessly among the worlds of research, practice and policy.

By
Sadie F. Dingfelder

Monitor Staff

September 2010, Vol 41, No. 8

Print version: page 48

As the director of the interdisciplinary Growth and Nutrition Clinic at the University of Maryland School of Medicine, Maureen Black, PhD, sees many poor children who are not growing or developing normally. In that role, she collaborates with pediatricians and dietitians to address kids’ medical and nutritional needs. She also uses her pediatric psychology training to help families establish consistent routines and expectations around mealtime. By using videotaped observations of families during a meal, she helps mothers recognize children’s hunger and satiety cues, so they can encourage healthy eating without pressuring children, emotionalizing food or resorting to unproductive battles around eating.

Black’s interventions, however, often go beyond the clinic, as she and her staff help families connect with public assistance and nutritional programs, such as the Special Supplemental Nutrition Program for Women, Infants and Children (known as WIC), a program run by the U.S. Department of Agriculture that provides healthy food and nutrition education to poor pregnant women and children under 5.

“It’s humbling, but there’s nothing we can do as health-care providers that would ever be as powerful as getting people access to housing and healthy, nutritious food,” she says.

That truth spurred Black to extend her work well beyond the clinic — and with more than 200 million children under age 5 not meeting their developmental potential worldwide, Black knew she had to go big. Over the last three decades, she’s built national and international coalitions to investigate the factors behind malnutrition and poor child development, and she’s worked with government agencies to put her findings to use. Along the way, Black’s conducted groundbreaking research resulting in more than 200 papers on topics such as micronutrients, obesity prevention, prenatal drug exposure, HIV/AIDS prevention, teen sex, and the effects of anxiety, depression, stress and drug abuse on parenting.

All the while, she’s continued working in her clinic, mentoring postdocs at the medical school as well as graduate students from the University of Maryland Baltimore County and the Johns Hopkins Bloomberg School of Public Health, where she holds adjunct professorships.

“Her work in all these different areas keeps her running around like crazy, but I think it energizes her as well,” says Sarah Oberlander, PhD, a former student of Black’s who is now a policy fellow at the Society for Research in Child Development. “I’ve seen her fly back from doing research overseas and come to the office directly from the airport. If she could bottle that energy, I think people would buy it.”

Supporting a crucial program

Though Black spends much of her energy overseeing large-scale research projects in the United States and abroad — including NIH-funded studies on infant and toddler feeding styles, adolescent obesity prevention and adolescent consequences of prenatal substance exposure — she makes time for clinical work because it keeps her in touch with the realities of poverty.

“I learn a tremendous amount from the families; they keep me honest,” she says.

In particular, Black’s clients showed her how bureaucratic barriers, such as mandatory appointments that conflict with work schedules, can keep them from using WIC. Other families simply don’t know about the program or don’t realize they are eligible, Black found. She accepted an invitation to join the Maryland WIC Advisory Council to ensure that the program operates efficiently and reaches eligible participants.

A vibrant research program grew out of Black’s work with WIC, including a statewide survey of infant feeding practices, which resulted in six papers. One, published in 2008 in Maternal and Child Nutrition (Vol. 110, No. 4), investigated why so many poor women try, but prematurely quit, breastfeeding their infants. Black and her colleagues found that poor Hispanic women were the most successful group in the study, breastfeeding for five months on average, as compared with poor black mothers who breastfed for 3.5 months on average and poor white mothers who breastfed for about three months. All three groups, however, were falling far short of the six to 12 months of breastfeeding recommended by the American Academy of Pediatrics.

The researchers also found that the women in the study quit for different reasons, with Hispanic women citing concerns that their milk supply was dwindling, while black women were more likely to report they had to quit breastfeeding due to their work schedules. Both black and white women also cited pain and discomfort as reasons for quitting.

The study was part of the doctoral dissertation of Black’s advisee, Kristen M. Hurley, PhD. Hurley, now a pediatrics professor at the University of Maryland, works with Black and WIC to develop culturally sensitive ways to increase breastfeeding among poor mothers.

“Maureen’s input is so valuable to our program, showing us how we can offer the best services to our participants,” says Jackie Marlette Boras, who directs Maryland’s WIC program.

Sharing science

In addition to helping WIC improve its services, Black works to keep the program afloat.

What makes her stand out among a crowded field of advocates, says Boras, is Black’s ability to draw on more than a decade of data collected on more than 36,000 children by Children’s HealthWatch, a group Black helped found. The organization counts, weighs and measures children under age 3 who show up in emergency rooms and primary-care clinics nationwide to investigate how federal initiatives such as WIC and welfare reform affect children’s health and development. Children’s HealthWatch has found, for example, that children who receive WIC are more likely to have healthy heights and weights than those who are eligible but not enrolled in the program. They’ve also shown that WIC children are less likely to have developmental problems, ensuring that they enter school more ready to learn.

“These are things your grandmother could tell you,” says Black. “But sometimes, as a country, we need reminding that giving our youngest citizens basic things, such as nutrition and access to early intervention programs, are good investments.”

In June, Black took her case directly to the public by writing an op-ed for the Baltimore Sun, asking readers to support the Healthy, Hunger-Free Kids Act of 2010, which would increase child nutrition funding by $4.5 billion over the next 10 years, expanding WIC and also allowing more children to enroll in free and reduced-price school lunch programs. In the piece, she laid out the importance of WIC, especially given the current recession, which has resulted in an increase in demand for WIC services from 7.9 million participants in 2004 to more than 9.2 million in 2009.

“Children’s young bodies and brains cannot wait for an economic recovery,” she wrote.

Black feels that writing op-eds and policy briefs is an essential part of her role as a psychologist.

“It’s our job to assist policymakers and help them make good decisions about kids,” she says.